Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0934

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-36140169

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road, Plaza 5, Suite 101

City: Ontario

Prov / State: Mississauga

Country: Canada

Postal Code: L5N2R7

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

06-FEB-14

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

05-FEB-14

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

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PMRA Registration No. 28258      PMRA Submission No.       EPA Registration No.

Product Name: Ortho Home Defense Max Perimeter/Indoor Insect Control RTU

• Active Ingredient(s)
  • PERMETHRIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye
  • Symptom - Itchy eye
  • Symptom - Red eye

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-36140169 - The reporter, a home owner, indicated that he was exposed to a pesticide containing the active ingredient permethrin. The reporter stated that he applied the product in his kitchen cupboards, around lunch time, one day prior to initial contact with the registrant. Then around 1 or 2pm that same day, his eyes became irritated and the following morning he woke up with red and itchy eyes. The reporter did not notice any direct contact with the product during application but he was not wearing eye protection and his head was near the cupboards while he sprayed. He did have a face mask on during application. On follow-up call, one day later, the reporter indicated that his eyes were still irritated and he had not yet sought medical attention. Immediate medical attention was recommended for the persistent irritation. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.